The disorders affect 1 in 20 children, and they can pose challenges in learning and activity.
The terms are used interchangeably, but there are distinct differences between them. Although the two terms are used, it should be noted that the American Psychiatric Association (APA) only recognizes the term "Attention-Deficit/Hyperactivity Disorder" in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
What are ADHD and ADD?
ADD and ADHD may often be confused, but there are distinct differences between the two.
Attention deficit hyperactivity disorder (ADHD) describes a condition of the brain that leads to a combination of poor attention, hyperactivity, and poor impulse control with a severity that interferes with functioning or development.
There are three subtypes of ADHD:
- Predominantly inattentive ADHD features forgetfulness, disorganization, and lack of focus. This particular type of ADHD is also called attention deficit disorder (ADD).
- Predominantly hyperactive-impulsive ADHD involves restlessness and impulsive decisions, but not inattention.
- Combined ADHD is characterized by inattention, hyperactivity, and impulsivity.
It is a common misconception that everyone who has ADHD is hyperactive. However, those people who present many ADHD symptoms, but are not hyperactive, may have inattentive ADHD, which was once referred to as ADD.
People with ADD will often have problems with disorganization and forgetfulness on a regular basis. They may also struggle to focus on things that are unimportant to them.
People with ADD can focus, and if a topic is interesting to them, they may focus on it completely, shutting out everything else. They are likely to find it most difficult to focus when undertaking regular, less interesting tasks, such as the laundry, doing homework, or reading office memos.
According to the DSM-5, people with this cluster of symptoms would still be diagnosed with ADHD, but would be given the "predominantly inattentive presentation" specifier.
The signs and symptoms for people with ADD or ADHD are similar, but they vary depending on the type of disorder.
The DSM-5 lists the diagnostic criteria for a range of mental conditions.
Inattentive ADHD, or ADD
People with this form of ADHD, or ADD will not present signs of hyperactivity.
But, they may present the following symptoms:
- Having trouble organizing tasks or activities
- Being easily distracted from the task at hand
- Regularly forgetting daily activities
- Regularly losing things that are needed to complete tasks
- Avoiding, disliking, or postponing tasks that are not interesting
- Regularly losing focus on schoolwork, chores, or duties in the workplace
- Not following clear directions
- Seeming to not listen when being spoken to
- Regularly making careless mistakes
- Having trouble holding attention on tasks or social activities
People with hyperactive-impulsive type ADHD will not present signs of inattentiveness.
Instead, people with this type of ADHD will show signs of:
- Always being "on the go"
- Squirming in their seat, fidgeting with objects on their desk, or tapping their hands or feet
- Regularly leaving their seat in situations where staying seated is expected, such as in work meetings, classrooms, and presentations
- Talking excessively
- Having trouble waiting their turn
- Often interrupting others in conversation or intruding on activities
- Often blurting out answers before a question is finished
When someone shows symptoms of both ADD and hyperactive-impulsive ADHD, they may have combined ADHD.
Showing any combination of these symptoms alone is not sufficient for a diagnosis.
Disorganization and forgetfulness may be symptoms of inattentive ADHD or ADD, but many conditions must be met for a correct diagnosis.
Someone who forgets their keys often or talks excessively does not necessarily have ADD or ADHD. A person must meet many conditions before being eligible for a diagnosis.
A child must have at least six of the above symptoms before they can be considered for diagnosis. In an adolescent or adult, five of these symptoms must be present.
The symptoms must be present for at least 6 months before diagnosis, and three or more symptoms of inattentive or hyperactive-impulsive behavior must have been present before the age of 12 years.
The severity of symptoms is also important.
Everyone forgets their keys from time to time, and many children do not like doing homework. In a person with ADD or ADHD, however, these symptoms severely affect their social, school, or work life.
The symptoms will also be inappropriate for a person's developmental level. An example of this might be a high school student who regularly climbs on top of the classroom table.
Symptoms must also appear in multiple environments, such as school, work, home, and in social situations. There needs to be clear evidence that the symptoms interfere with the individual's quality of life.
Doctors will also consider whether these symptoms can be explained by other disorders.
Is a child simply rebelling against authority? Are their behaviors a cry for attention? With possible cases of ADHD or ADD in children, a school psychologist may be invited to observe the child's behavior in their classroom environment, to help make a proper diagnosis.
Other conditions that cause similar symptoms
Doctors also need to be sure that the behaviors are not caused by another disorder. Mood disorders, anxiety disorders, personality disorders, and dissociative disorders can all show similar symptoms to ADD or ADHD.
Children with ADHD have a higher risk of other disorders. The Centers for Disease Control and Prevention (CDC) estimate that about half of children with ADHD have other disorders as well.
Behavioral problems often accompany ADHD in children. Oppositional defiant disorder and conduct disorder may be present, as well as learning disorders, anxiety, and depression.
These other disorders may make it difficult to diagnose or treat ADHD, and they can make it harder for the child, their parents, teachers, and peers. This is another reason it is so important to be sure the diagnosis is very thorough.
The symptoms of ADHD and ADD can be helped with lifestyle changes:
- eating a balanced, healthful diet
- getting plenty of exercise
- establishing good sleeping practices
- co-ordinating with the school, if the condition affects a child
Medications, such as Ritalin or Adderall, may need to be used.
A doctor will advise on the best strategy for treating ADHD or ADD.
When to see a doctor
Any diagnosis of ADD or ADHD must be carried out by a healthcare professional, who will first decide if the individual meets the required criteria.
Understanding the complexity of ADD and ADHD helps to prevent irritation with the long diagnosis process, and it helps to avoid a misdiagnosis.
ADHD in adults and children
A child with hyperactive symptoms is more likely to display their hyperactivity through inappropriate behavior than an adult.
The symptoms of ADHD or ADD can shift and change as people mature, and the same symptoms may present differently in children and adults.
Children with symptoms of hyperactivity are more likely to appear "in motion" all the time. They may run, climb, and play excessively, even when it is inappropriate. In classrooms, they may get up, constantly cause distractions, and talk excessively. Children will often fidget in their seat, squirm, play with things in their hands, and have trouble sitting still.
In adults, physical signs of hyperactivity may be replaced by a feeling of constant restlessness. The hyperactivity may show up in other ways, such as constantly tapping their feet, playing with a pencil, or fidgeting.
They may move from job to job at the first sign of boredom, and they may leave uninteresting projects half-finished. Adults may still find it hard to sit still for extended periods.
Impulsive behaviors show up in adults and children in slightly different ways. Children are often seen as rude as they blurt out answers, move to the front of a line, interrupt others, or run in front of traffic without looking.
Adults may experience impulsive behaviors, such as spending money randomly, driving recklessly, or having a careless sexual life. They may also say what is on their mind without thought as to whether it is offensive or may hurt the other person's feelings.
In children, inattention manifests as careless mistakes in schoolwork, short attention span, incomplete homework, and unfinished activities. They also may not pay attention to details or listen when being spoken to directly.
In adults, the symptoms of inattention are similar, but they emerge in different ways. Adults may forget to do regular tasks, such as taking out the garbage, picking their kids up from school, or filing paperwork.
They may lose or forget things they use regularly, such as keys, phone numbers, and important papers. Adults with ADD may also have problems with self-motivation.